A review of refractive outcomes of combined cataract and Descemet Stripping Automated Endothelial Keratoplasty (DSAEK) at Moorfields Eye Hospital (MEH), London UK, between 2009 and 2011 demonstrated a mean 1.1 dioptres (D) of hypermetropization post-operatively. During this period all graft material was surgeon cut. Since June 2013 all donor material has been precut by technicians at the Moorfields Lions Eye Bank (MLEB). In May 2014 their technique was refined resulting in ultrathin grafts (sub100 microns). However, the impact of ultrathin precut donor material on refractive outcome is unknown. This study investigates the refractive outcomes of ultrathin pre-cut grafts in combined cataract and DSAEK surgery at MEH.

Methods

We retrospectively analysed the records of all patients who underwent combined cataract and DSAEK since May 2014. We collected data on pre-operative and post-operative best-corrected visual acuity (BCVA) and refraction and intraocular lens (IOL) refractive target.

Results

A total of 21 cases of combined cataract and ultra thin precut DSAEK surgeries were identified from the hospital database. Data were collected for 19 eyes of 16 patients with a mean age of 72 years (range: 59 to 83). Indications for surgery were Fuchs’ endothelial dystrophy (18) and one failed penetrating keratoplasty. There was no co-morbidity in seventeen eyes. One had early glaucoma and one was amblyopic. Visual and refractive outcomes are reported in table 1.<br /> <br /> Median IOL refractive target pre-operatively was -1.03 DS (range: -1.6 to +0.98). Median post-operative hypermetropization from IOL refractive target was +0.46DS (range: -0.75 to +3.15).

Conclusions

Ultra-thin pre-cut donor lenticule exerts less hypermetropization on refractive outcomes than reported for surgeon cut. These results suggest that IOL target refraction should be readjusted for ultrathin pre-cut donor tissue in combined cataract and DSAEK surgery.